Khalid, Tengku Noor Farhana Tengku
(2018)
Pulmonary tuberculosis and tobacco smoking : factors associated with its mortality in Terengganu from 2012 until 2016.
Masters thesis, Universiti Sains Malaysia.
Abstract
Background: Tuberculosis (TB) is a major public health problem. The incidence of
TB cases is reducing at a slower rate than expected as well as the TB death rate
worldwide. However, the incidence of TB cases in Terengganu had increased from the
year of 2009 until 2012 and had been fluctuating until 2016. The number of tobacco
smoker in Malaysia had reduced accordingly. Little studies have been done to analyse
tobacco smoker with pulmonary tuberculosis (PTB) patients as the subjects to
determine the factors for its mortality.
Objective: The aim of this study was to determine the proportion of mortality and the
associated factor with mortality among PTB patients who smoke tobacco in
Terengganu from 2012 until 2016.
Methodology: A case-control study was conducted in April 2018 using a secondary
data from MyTB System and from TBIS10A1 forms. The proportion of mortality
among PTB and tobacco smoker were calculated based on the data extracted from
MyTB System with no sampling method applied. Simple random sampling using a
computer software was applied to select 185 cases and 740 controls. A case is the PTB
patient who smokes tobacco smoking who had died during the TB treatment. A control
is the PTB patient who smokes tobacco and was cured or completed TB treatment.
Descriptive analysis, simple and multiple logistic regression were used for analysis
using SPSS version 24.
Result: The proportion of mortality among PTB and tobacco smoking patients were
between 14.8% and 23.4%. From the 925 selected respondents, the mean age for the
case was 48.6 years (14.87) and the mean age for control was 45.8 years (15.32).
Majority of the respondents are male, Malays, from a rural area, have the educational
status of Form 4 and above, had no fixed monthly income, non-diabetic, received BCG
immunisation, detected passively, diagnosed as PTB smear positive and were new
cases. Almost half of the cases were HIV positive and the majority of the controls were
HIV negative. More than half of the cases had chest x-ray results of moderately
advanced while more than half of the controls had chest x-rays results of minimal. Age
(aOR=1.04; 95% CI: 1.03, 1.05; p<0.001) and HIV positive (aOR=9.51; 95% CI: 6.08,
14.88; p<0.001) were the factors contributing to mortality among PTB and tobacco
smoking patients. Meanwhile, diabetic patient (aOR=0.58; 95% CI: 0.35, 0.94;
p=0.028) and having monthly income of more than RM 930 (aOR=0.38; 95% CI: 0.20,
0.73; p=0.003) had less risk for mortality.
Conclusion: The proportion of mortality among PTB patients who smoke tobacco is
reducing slowly from 2012 until 2016. Factors associated with mortality among PTB
patients who smoke tobacco should be focus more in the national TB control
programme in order to reduce the mortality risk.
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